AIDS in Prison Update

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Another month, another study. In March, researchers at UC-Berkeley reported that the increase of HIV/AIDS among African-Americans correlated strongly with the increase in incarceration rates among black males. This month a new study just published by the Centers for Disease Control finds, according to the Washington Post, that "about 90 percent of HIV-positive men in Georgia's prison system—the nation's fifth largest—were infected before they arrived."

Based on the first study, I wrote a passionate column about the need for pre- and post-incarceration HIV testing and arguing that officials should provide condoms for protection of prisoners. The good news is that the CDC study suggests that the HIV transmission problem in prison is not as great as I and others feared. Even though the urgency seems less, I still think that it is a good policy to test all inmates and to provide them with condoms. (Aside: One interesting insight from the new study is how common sex between staff and prisoners is.)

So if exposure to HIV in prison is a lesser problem than the Berkeley study suggested, what can account for the higher rates of infection among African-Americans in prison? Other CDC data on how various ethnic groups acquire HIV infections points to another possible correlation. It turns out that the rate of injection drug use in percentage terms is almost three times higher among HIV-positive black Americans than among HIV-positive whites.

Hypothesis: Perhaps the higher HIV infection rate among black prisoners correlates with higher incarceration rates resulting from the differential impact of the drug war on the African-American community.

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  1. That column was pretty passionate. I had a wet dream after reading it.

  2. That column was pretty passionate. I had a wet dream after reading it.

  3. Not to sound crass, but does anyone really think that the provision of condoms will really work? Personally I doubt that they would be used all that often.

  4. “Hypothesis: Perhaps the higher HIV infection rate among black prisoners correlates with higher incarceration rates resulting from the differential impact of the drug war on the African-American community.”

    Sounds logical to me.

    Garth, I also don’t think the prisoners will pause the unwanted sexual assault to install a condom. I am cynical that way I guess.

  5. In my experience, significant numbers of incarcerated men engage in consensual sexual relationships in prison, even in the face of regulations that punish inmates who engage in such behavior. Many of them would likely welcome the opportunity to use condoms.

  6. Does anybody have any numbers on how prevelent sexual assault and rape are in prisons? Because I don’t think that if you get sent to prison you’re automatically going to get ass-raped by some huge murderer, as is the common conception.

  7. Garth, I also don’t think the prisoners will pause the unwanted sexual assault to install a condom. I am cynical that way I guess.

    Yeah, that’s kind of what I was thinking. The only reason I don’t break the law is I’d be terrified for the sanctity of my ringpiece if I went to prison.

    I can’t imagine prison services would be likely to conduct a survey as to whether the spread of HIV was down to consenual or forced sex.

  8. If drugs were legal, would that do a lot to close the gap in a lot of achievement measurements between blacks and whites? I have a feeling that it would.

  9. If drugs were legal, would that do a lot to close the gap in a lot of achievement measurements between blacks and whites? I have a feeling that it would.

    Possibly. But then we would have to bring in discrimination laws to protect the crackheads.

  10. Consensual or not, I am betting that “bare-back” would still be the preferred choice since pregnancy is not a risk.

    Prisoner one: “I ain’t wearin’ no condom. It like taking a shower with a raincoat on!”

    Prisoner two: “Well then, when it my turn I won’t either!”

  11. In re:

    “Other CDC data on how various ethnic groups acquire HIV infections points to another possible correlation. It turns out that the rate of injection drug use in percentage terms is almost three times higher among HIV-positive black Americans than among HIV-positive whites.”

    I think your hypothesis is solid.

    I also think you might want to re-examine the allegedly “penile-vaginal” epidemic spread in Africa in light of this result, and look more at the chronic use of dirty needles in African health care.

    Especially in light of this on-the-ground recent rigorous study:

    Potential for HIV transmission through unsafe injections. AIDS. 20(7):1074-1076, April 24, 2006.
    Apetrei, Cristian a,b; Becker, Joseph a; Metzger, Michael a; Gautam, Rajeev a; Engle, John a; Wales, Anne Katherine a; Eyong, M c; Enyong, Peter c; Sama, Martyn c; Foley, Brian T d; Drucker, Ernest d; Marx, Preston A a,b

    Abstract:

    We tested for HIV in discarded needles and syringe washes from 191 HIV-infected patients receiving injections in rural Cameroon. HIV-1 RNA was amplified from 34 of 103 intravenous injection syringes and two of 88 intramuscular injection syringes. All 36 strains were HIV-1 group M. The majority belonged to the circulating recombinant form CRF02 (IbNg). Our data support a role for unsafe injections in the spread of HIV-1 in Africa, in contrast to recent studies.”

  12. Another hypothesis that seems reasonable to me is that African Americans are simpl more susceptible to infection by HIV.

  13. Christopher Cornwell and I have a working paper on how declining sex ratios in Black communities affects male sexual behavior. We find a strong effect of declining sex ratios over time on the number of sex partners Black males reported having in the last twelve months. Specifically, if you imagine a ratio of females to males at the state level, we find that a 10% increase in that ratio (meaning, males are being removed, causing the denominator to decrease, and the ratio to increase) leads to a 20% increase in the number of sex partners black males reported over the last twelve months. This is robust to a number of demographic controls (age of the respondent at the time of the survey, their age-squared, the highest grade completed, whether biological parents are still married), controls for the year the survey occurred, controls for the state the person lived in, controls for state-year effects, and controls for individual “fixed effects”, which allows to net out time-invariant heterogeneity at the individual level.

    Other studies by Adaora Adimora at UNC-Chapel Hill note that incarceration could affect female health outcomes indirectly by changing the dynamics of the marriage market. By creating a shortage of Black men in the marriage market, men might respond to their improved bargaining position by having more serial monogamy or increased concurrent sex partners – both of which could explain the rise in the AIDS over long stretches of time. It’s largely believed that the racial disparity in HIV/AIDS prevalence is due to the differences in the composition of each ethnicity’s respective sexual networks. That is not inconsistent with Johnson and Raphael’s 2005 working paper, either. They explicitly note in the paper that incarceration could affect HIV/AIDS outcomes, not merely by incapacitating prisoners (and thus exposing them to sexual risk), but also by affecting the marriage market in the ways just outlined. That is consistent with their results (and our results, as well).

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